The CDC (the Centers for Disease Control and Prevention), with the guidance of the AAP (the American Academy of Pediatrics), recently changed the developmental milestone checklists. These lists guide pediatricians and pediatric professionals on what would be considered typical development. Although the guidelines needed a clearer and more concise update for parents, some professionals are not happy with the new facelift.
Out with the Old…
In 2004, the CDC’s Learn the Signs, Act Early Program established the developmental milestone checklists that utilized the 50th percentile (average-age) milestones. This means that only half of the child population can be expected to achieve that milestone by that age. With this method, clinicians reported that these guidelines weren’t helpful to families who had concerns about their child’s development, resulting in a “wait-and-see” approach that would possibly delay appropriate diagnosis and early intervention.
The purpose of changing the checklists were to:
- Identify evidence-informed milestones to be included into the checklist
- Clarify when most children can be expected to reach a milestone
- Support clinical judgement regarding screening between recommended ages
To clarify, a milestone is a developmental skill most kids should do by a certain age. But, that skill can occur over a certain age range. For example, independent sitting can happen between 7-9 months. If my child wasn’t sitting by 7 months but eventually reached it by 8 months, I the parent wouldn’t worry. But if my child wasn’t sitting after 9 months, that is bigger red flag and I would consult my pediatrician.
The new milestones were discussed by a group of 13 developmental experts and pediatricians. After ciphering through multiple sources and data, they created what they believe is an accurate depiction of a child’s development.
The goal of the change is to identify issues sooner than later, ease parent stress about their kid’s development, and encourage open, maintained communication between parents and pediatricians about their child’s current and future developmental progress.
…In with the New
So, what are the big developmental milestone changes?
The new developmental platform raised the percentage of children who meet certain milestones sans intervention from 50% to 75%, meaning that the greater majority of children should be capable of certain behaviors and achievements at specified ages, instead of just half. So, if your child isn’t meeting a milestone by the indicated time, it should be brought to your pediatrician’s attention, as 75% of children at that age are reaching or have already reached that milestone. This also allows for early intervention and recommendations to the appropriate specialists to help children catch up to their peers. Studies show that early intervention can help reduce the chance of an autism diagnosis later. A 2021 study found that parent-led therapy in babies showing early signs of autism spectrum disorder (ASD) reduces the chance of a diagnosis at age 3 by 66%.
The new guidelines also removed medical jargon, making it easier to understand. For example, rather than using the term “object permanence”, they say “looks for things he sees you hide, like a toy under a blanket.” Vague or ambiguous words like, “may” or “begins” have been replaced with more direct language to eliminate any confusion on what milestones should achieve by each stage.
Additionally, the revised milestones place an emphasis on developmental surveillance over screening tests, which is meant to serve as an open dialogue between parents and pediatricians to meet developmental goals.
A notable change regarding the checklists is the fewer developmental achievements to be met at each age. The CDC removed more than half of the previous 216 milestones across the 10 checklists, some being duplicate objectives. However, they included more social and emotional milestones like smiling (by 4 months) or showing caregivers attention (by 15 months). They also incorporated two new checklists with additional milestones for babies and toddlers at 15 and 30 months, bringing the total to 159 milestones across 12 checklists. The checklists also come with revised tips and suggestions for parents to support their child’s development.
Why the Pushback?
Change doesn’t come without a little bit of resistance and these new guidelines are no exception.
In the realm of speech and language development, the American Speech-Language-Hearing Association (ASHA) stated that some of the new milestones do not align with their specified speech, language, and social-communication milestones, utilized by speech-language pathologists (SLPs) and other professionals to assess a child for possible communication or developmental delay/disorder. Because of this discrepancy, they fear that children may be identified later than desired, encouraging the wait-and-see process rather than eliminating it.
The previous developmental milestone checklist stated that children at 2 years of age should be able to say 50 or more words; however, the new guidelines pushed this age to 30 months. They also point out that by delaying the expectation of 50+ words, it is contradictory to keep the achievement of combining two words at 24 months. SLPs argue that a child needs at least 50 words before putting two words together.
ASHA’s concern is that the postponement of speech and language will result in a domino effect of delays for speech services in school, like getting an individualized family service plan (IFSP) or individualized education plan (IEP).
Another area of controversy comes from the removal of crawling, a milestone that was previously recommended to achieve between 6-10 months of age. Pediatric OTs and PTs contend that crawling is essential to child development, serving as a red flag to possible physiological and neurodevelopmental issues, like postural control, muscle tone, coordination, or integration of primitive reflexes. Despite crawling being an important method of movement (and something we still highly recommend), it is not necessary in achieving the milestone of walking.
OTs also express concern that roughly one-third of milestones, most being fine motor skills, have been bumped up to older ages. It is possible that children may worsen their developmental delay and making it difficult to provide early intervention. Someone who was originally one standard deviation from the norm is now two standard deviations in assessments, snowballing into other developmental issues that could have been remedied if caught sooner.
In the End, Does it Even Matter?
As parents, we rely on developmental milestones to gauge where our kids are in comparison to others. We think they’re little geniuses if they achieve them early and worry they may be struggling if they reach them late. Despite the changes, remember that these milestones are not an indicator of what or how your kids will be in the future. It merely serves as a method to help find children that need a little more assistance to achieve developmental goals, supporting families through close monitoring or early intervention to provide the best outcomes for your child.
If your child is not meeting a milestone per these new guidelines, you should consider supplying the tools to help foster that skill OR see a specialist in that area to guide you.
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Developmental milestones just changed for the first time in years – The Washington Post
CDC & AAP Changed Developmental Milestones for Babies (mother.ly)
Evidence-Informed Milestones for Developmental Surveillance Tools | Pediatrics | American Academy of Pediatrics (aap.org)
New Developmental Milestones: Reviewing the Changes and Evidence (asha.org)
The CDC Updated Their Developmental Milestones for Kids—Here’s What Parents Need to Know | Parents
Whitehouse AJO, Varcin KJ, Pillar S, et al. Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis. JAMA Pediatr. 2021;175(11):e213298. doi:10.1001/jamapediatrics.2021.3298
Milestone Moments Checklist (cdc.gov)